The identification and treatment of depressive disorders in adolescents with chronic physical illness is an understudied area. The purpose of this Mentored Patient-Oriented Research Development Award (K23) is to enable the candidate to become an independent clinical researcher in the area of innovative approaches to evaluation and treatment of depression in adolescents facing physical illnesses. The proposal will focus on patients with inflammatory bowel disease (IBD). The project will be conducted at Children's Hospital Boston (CHB), where a large population of adolescents with IBD is available. William R. Beardslee, MD, with expertise in depressive disorders and prevention, will serve as the primary mentor. John March, MD, MPH and John Weisz, PhD, experts in clinical psychiatric outcome research and psychotherapy interventions, will serve as co-sponsors. Research plan: The aims are: 1) Conduct randomized comparison trial of cognitive behavioral therapy (CBT) enhanced with physical illness narrative, family education, and social skills components (n=24) to standard of community care treatment (n=24) in depressed adolescents with IBD, and 2) Investigate underlying neurobehavioral changes in adolescents with depression and IBD. Career development plan: The training will emphasize skills necessary for conducting comparative clinical trials in the treatment of depression in adolescents with chronic physical illness and begin to explore underlying neurological mechanisms of the disease process. Didactic work in intervention research design and statistics, developmental psychopathology, and assessment of methodologies for biological and neurobehavioral correlates of treatment response will complement supervision by the program consultants. With a sound understanding of pathobiology and change mechanisms, the long-term goals of the candidate are to develop and evaluate cognitive-behavioral and pharmacological treatments for physically ill children and adolescents with depression and to investigate neurobiological correlates of treatment effect.